PinK: Flat-out fabulous: More women are sharing why they delayed or rejected reconstruction

Melissa Erickson More Content Now

Wednesday

Sep 25, 2019 at 1:45 PM

This article appears in Paint It All Pink magazine 2019.

Diagnosed with breast cancer in 2009, health journalist Catherine Guthrie felt prepared. She knew her options. Her choice was a lumpectomy.

But as a small-breasted woman Guthrie was told she was not a good candidate for lumpectomy. Instead, her surgeon suggested a single mastectomy along with a plan for reconstruction that seemed shocking to Guthrie but turned out to be quite common: Her breast would be reconstructed by severing the largest muscle of the back, wrapping it around and laying it over a breast implant.

“Is this for real?,” Guthrie remembers thinking. While not a hard-core athlete, Guthrie felt it was an invasive surgery that would affect her body’s ability to function. She would no longer be able to do handstands, which always gave her a sense of strength.

With mastectomies, women have choices, and more of them are choosing to go flat.

Many optionsWhen faced with breast reconstruction, women are asked to choose between the artifice of looking like man’s idea of a woman or the feeling of strength and power in their own bodies, Guthrie said.

Guthrie chose to go flat and shared her story in a memoir, “Flat: Reclaiming My Body from Breast Cancer.”

Going flat is a form of radical honesty, Guthrie said. It’s about body positivity, about coming out of the shadows.

“I can still be a woman, be sexy and empowered, strong and confident,” she said.

The No. 1 reason women choose to go flat is for their health, said Dr. M. Michele Blackwood, chief of breast surgery at Rutgers Cancer Institute of New Jersey. Recovering from a mastectomy without reconstruction is easier because it’s a less complicated surgery. There’s less chance of infection or other complications. Recovery is quicker.

Some don’t want a foreign implant or feel strongly that their breasts don’t define who they are, said Barbara Kriss, founder of BreastFree.org, a website for women with breast cancer who opt not to have reconstruction after mastectomy surgery.

“Others do want to preserve their natural shape in clothes but prefer to use external breast forms as opposed to internal ones,” Kriss said.

Cost can also be an issue, Blackwood said. Today surgeons are required by law to discuss the myriad choices women have, from same-day reconstruction surgery to going flat, she said.

“Know that you are your own best advocate. Do your homework. Know that you have multiple options and that reconstruction is always an option even years later,” Guthrie said.

Things to considerAccording to a 2014 study published in the Journal of Clinical Oncology 25% of double mastectomy and 50% of single mastectomy patients chose to go flat.

The stress of cancer coupled with major surgery “can put women in paralysis mode,” but the decision can be put off, Blackwood said. In delayed reconstruction — whether for six months or 10 years — a tissue expander is inserted as a placeholder, she said.

“Many more women are opting to not get reconstruction after their mastectomies, and now there is a growing trend toward women getting explant surgery many years later and opting to go flat,” said Nanette Labastida, an Austin, Texas, residential real estate professional. “My surgery is scheduled for October, nine years after mastectomy with implants.”

For aesthetics and comfort, a mastectomy should be as cosmetically pleasing as possible, leaving the patient with a smooth, flat chest, no extra skin and symmetrical incisions (for a bilateral mastectomy), Kriss said.

For women who are big breasted and/or overweight, sometimes extra, non-breast tissue is left after a mastectomy, particularly under the arms, Kriss said. Commonly known as “dog ears,” this can be uncomfortable and unsightly but can be removed by a plastic surgeon as a minor outpatient procedure, which may or may not be covered by insurance.

How going flat has evolvedPreviously “going flat” generally referred to women who chose not to have reconstruction and opted not to wear breast forms after a mastectomy, said Kriss.

“In the years since, the term has evolved to encompass all women who opt not to have reconstruction, even though many of those women may wish to wear breast forms,” she said.

The distinction has been lost. Women considering not having reconstruction may hear the term “going flat” and may not realize that being flat doesn’t mean they can’t have the shape of natural breasts in clothes if they wish, Kriss said.

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